Treating the Pain – What area doctors are doing to combat the opioid epidemic

The reach of the opioid epidemic into Fort Wayne became clearer July 2017, when a Fort Wayne doctor and two pharmacists were indicted in the nation’s largest health care fraud take down ever.

Dr. James Ranochak and pharmacists Brent Losier and Charles Ringger faced nearly a dozen charges including illegally prescribing and distributing controlled substances including testosterone, hydrocodone and methadone to patients without properly examining and testing them first. Prosecutors said it was all to cheat the system and pocket thousands of dollars.

The case is still making its way through the court system and a trial is set for March 2019 but it raises the question – have doctors played a role in the nationwide epidemic – either deliberately for their own gains or unknowingly just trying to help patients.

Many in the medical field said people like Ranochak, Losier and Ringger are a small minority casting a negative light on the others in the medical community who genuinely want to help people. Unfortunately, even doctors with the best of intentions may contribute to the epidemic. There is good news – experts say Fort Wayne is on the right track to change that, but there’s still a long way to go.

Every day Dr. Daniel Roth arrives to work at Summit Pain Management hoping to make a patient’s life better.

“We take a patient who has pain and our goal is to make them functional,” Roth said.

He’s practiced pain management for nearly a decade and he sees many patients every day – some in similar situations, but not all have the same treatment plan.

“As time has moved forward, I think [there’s] general awareness across the board in the medical community that opioids aren’t the only way to treat pain and they’re not anywhere near the best way to treat pain,” he said.

Data from the Allen County Health Department show the number of people who overdosed rose from 802 in 2016 to 1,200 in 2017 which is a nearly 50-percent increase. The number of people who died from drug overdoses more than doubled from 68 in 2016 to 127 with the majority of the cases opioid related whether it be prescription or illicit drugs. They are startling numbers, but a harsh reality signaling that something needed to change.

Physicians over time have somewhat contributed to the problem,” Roth said. “Doctors don’t like change. When you have this epidemic on top of that, then you start getting to the point [of] where we have to change because now we really see this negative consequence of what we thought was a good option.”

Roth said the new state law requiring healthcare professionals check the state’s prescription database INspect before prescribing medications will help in the fight especially in cutting down on patients who doctor shop. He’s also a member of the Regional Mental Health Coalition of Northeast Indiana working with others in the medical field, local leaders and law enforcement to find solutions.

In the meantime, Roth’s practice continues a move away from opioids and encourages other ways of treating pain like a healthy diet and exercising.

“Are they [opioids] a part of some treatment plans – absolutely,” he said. “But we really try to get patients using all of the tools that are available to them that’s not a prescription [and] that’s not an injection. Then we can build on top of that the things that we can do which are many.”

Most importantly, Roth said he focuses on properly monitoring patients.

“It boils down to really understanding that patient when they come in – taking the time to look at the background and the history, do all of those things,” he said. “That’s the key to this. If we’re doing that, then patients on an opioid are going to be in a safer place because we’re going to be able to see a problem if it’s going to start.”

Dr. Roth said he’s seeing more patients being admitted earlier who are on lower doses of opioids and pain medications which is a good sign things are changing.

He also said it’s important to make sure the next generation of doctors is prepared and knows that there are other medications that are less risky than opioids and alternative treatment options as well.

Tess Walker is a 4th year medical student from Indiana University is wrapping up her latest rotation at Summit Pain Management. She said one of her biggest fears used to be treating patients with pain because of the risk of opioids.

Walker said early on in her studies she noticed IU making more and more of an effort teach best practices in treating pain – bringing in providers and physicians into the classroom to hear and learn from their stories. She also said the hands-on experience at Summit Pain Management has been invaluable.

“It is better to reassure the upcoming doctors, the students that it is okay to use all the tools at your disposal,” Walker said. “You just have to use some common sense and I think you’ll be okay.”

Roth said one of his biggest struggles is dealing with insurance companies as often times doctors are jumping through many different hoops to help patients because some treatments aren’t covered by insurance but some opioids are.

Parkview Behavioral Health has also created a brand new department dedicated to combating the epidemic here in the Fort.

The Opioid Treatment and Pain Services Department is only a couple of weeks old and officials said it focuses on finding solutions for treatment, education and prevention around the crisis.

The director of the department, Shawn Fingerle said while some may still require opioids as part of their treatment plan, studies have shown long-term uses of these medications especially at higher doses can actually make the pain worse.

“So really getting people either off of the medications as a strategy for pain management or on very low doses, that’s probably the best strategy,” Fingerle said. “We teach them strategies. We work with their depression, we work with their anxiety, we get them moving. Part of it is you want to exercise, you want to move you want to do yoga, you want to be stretching [and doing] physical therapy. “There’s other strategies that will actually help get your pain more under control.”

For more information on the Opioid Treatment and Pain Services Department at Parkview Behavioral Health, click here.

For more information on the Regional Mental Health Coalition of Northeast Indiana, click here.